Exploring the Relationship Between Treatment and Causal Theory in - PowerPoint PPT Presentation

Exploring the Relationship Between Treatment and Causal Theory in Stuttering Ann Packman, PhD Australian Stuttering Research Centre ESFD, Antwerp, 2014

Overview • Verbal communication and complexity theory • “What causes stuttering?” – causal models/theories – P&A 3-factor model • Do our treatments for stuttering address cause?

Spoken language • The most complex thing we humans do – thinking up we want to say – constructing the language to say it – programming this into motor gestures (syllables) – 4-6 syllables per second, each one unique – all this, taking into account • conversational partner • topic • purpose • context

Verbal communication and complexity theory Packman & Kuhn (ODC, 2008; IJSLP, 2009) • Complexity theory/sciences – nonlinear – initial condition and the “butterfly effect” – self-organising and dynamic

Communicative context MIND BRAIN BODY Communicative environment

“What causes stuttering?” • Many models and theories – Systems control modeling • Sensory Motor Modeling Theory • Neuroscience Model • Variability Model (Vmodel) – Speech motor control • Syllable Initiation Theory (SI Theory) • Interhemispheric Interference Model

Models and theories (cont.) – Cognitive and linguistic processing • Neuropsycholinguistic Theory • Covert Repair Hypothesis • Suprasegmental Sentence Plan Alignment Model • EXPLAN – Multifactorial • Demands Capacities • Dynamic Multifactorial Model

Let’s talk about cause Packman & Attanasio (2004) • Cause = necessary and sufficient conditions • Individual instances of a phenomenon can have triggers, e.g. bushfires

Rather than asking… “What causes stuttering?” we ask… “ What causes a moment of stuttering? ”

The Packman & Attanasio (P&A) 3-factor causal model of moments of stuttering Packman (ODC, 2011; JFD, 2012; Enfance, 2013) 1. Necessary neural processing problem 2. Trigger features of spoken language 3. Modulators inherent to the individual

P & A 3-factor model MODULATORS TRIGGER IMPAIRED NEURAL Inherent features of A MOMENT OF PROCESSING spoken STUTTERING for language spoken language • variable syllabic stress • linguistic complexity • physiological arousal • cognitive demands

FACTOR 1 Neural processing problem • Functional – Activations & deactivations • Structural – Volume – Diffusion Tensor Imaging (DTI)

Putting together the findings of recent imaging and genetic research Cykowski et al. (NeuroImage, 2010) Hypothesis: The neural processing problem underlying stuttering is incomplete or late myelination of the white fibre tracts subserving the production of spoken language

FACTOR 2 Variability of syllabic stress Packman et al. (CLP,1996)

FACTOR 2: Effects of linguistic complexity on motor stability see Smith and colleagues ( JSLHR, 2000) “Buy Bobby a puppy” “ You buy Bobby a puppy now if he wants one ”

FACTOR 3 Modulators Alm (JFD, in press), Eggers et al. (JFD, 2013), Jones et al. (JCD, 2014), Metten et al. (Dis. Rehab., 2011) • Determine the triggering threshold – physiological arousal • Anxiety? Excitement? Temperament? • influenced by environment – cognitive demands • multi-tasking

Evaluating the P&A 3-Factor Model • Explanatory power? Stuttering not normal disfluency Onset and development Topography Natural recovery Variability • Testability? • Parsimony? • Heuristic value?

Do our treatments for stuttering address cause? Behavioral treatments Other treatments designed to reduce PSYCHOLOGICAL stuttering (incl. CBT) DIRECT INDIRECT PHARMACEUTICAL MODULATING FACTORS TRIGGER IMPAIRED NEURAL Inherent features of A MOMENT OF PROCESSING spoken STUTTERING for language spoken language • variable syllabic stress • linguistic complexity • physiological arousal • cognitive demands

Theory and therapy Should theory drive therapy? Can therapy drive theory?

Thank you! Dankjewel! �

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